MEDICARE: UNIVERSITY OF MICHIGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1730230053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MICHIGAN

Provider Business Mailing Address
First Line	:	8736 BARRINGTON DR
Second Line	:
City	:	SUPERIOR TOWNSHIP
State	:	MI
Zip	:	48198-3289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8736 BARRINGTON DR
Second Line	:
City	:	SUPERIOR TOWNSHIP
State	:	MI
Zip	:	48198-3289
Country	:	US
Telephone Number	:	734-930-7400
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED ATHLETIC TRAINER
Name	:	MR. RYAN JAMES ANDERSON
Credential	:	ATC, CSCS
Telephone Number	:	734-930-7400

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/22/2020

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